Speech Sound Disorder
DSM-III In DSM-III, this disorder is called Developmental Articulation Disorder Diagnostic Criteria A'''. Failure to develop consistent articulations of the later-acquired speech sounds, such as r, sh, th, f, z, l, or ch. '''B. Not due to Developmental Language Disorder, Mental Retardation, Childhood Onset Pervasive Developmental Disorder, or physical disorders. Differential Diagnosis Other mental disorders In Developmental Language Disorder, Mental Retardation, Infantile Autism, and Childhood Onset Pervasive Developmental Disorder, language development is impaired, whereas in Developmental Articulation Disorder, language development is normal. Hearing impairment In hearing impairment, audiometric testing will reveal an abnormality, whereas in Developmental Articulation Disorder, hearing will be normal. Dysarthria In dysarthria (abnormal articulation due to disorders of the oral speech mechanism or to neurological abnormalities), there may be problems with chewing or sucking, drooling, the rate of speech may be slowed down, and vowel sounds may be affected. None of these are present in Developmental Articulation Disorder. DSM-IV In DSM-IV, this disorder is called Phonological Disorder. Diagnostic Criteria A'''. Failure to use developmentally expected speech sounds that are appropriate for age and dialect (e.g., errors in sound production, use, representation, or organization such as , but not limited to, substitutions of one sound for another of /t/ for target /k/ sound or omissions of sounds such as final consonants). '''B. The difficulties in speech sound production interfere with academic or occupational achievement or with social communication. C'''. If Mental Retardation, a speech-motor or sensory deficit, or environmental deprivation is present, the speech difficulties are in excess of those usually associated with these problems. '''Note: If a speech-motor or sensory deficit or a neurological condition is present, record the condition. Differential Diagnosis Mental Retardation, sensory deficits, speech-motor deficits, and severe environmental deprivation Speech difficulties may be associated with Mental Retardation, a hearing impairment or other sensory deficit, a speech-motor deficit, or severe environmental deprivation. The presence of these problems may be established by intelligence testing, audiometric testing, neurological testing, and history. If the speech difficulties are in excess of those usually associated with these problems, a concurrent diagnosis of Phonological Disorder may be made. Children with speech difficulties due to environmental deprivation may show rapid gains once the environmental problems are ameliorated. Other Communication Disorders Problems limited to speech rhythm or voice are not included as part of Phonological Disorder and instead are diagnosed as Stuttering and Communication Disorder Not Otherwise Specified. DSM-5 Diagnostic Criteria A'''. Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages. '''B. The disturbance causes limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or in any combination. C'''. Onset of symptoms is in the early developmental period. '''D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or neurological conditions. Differential Diagnosis Normal variations in speech Regional, social, or cultural/ethnic variations of speech should be considered before making the diagnosis. Hearing or other sensory impairment Hearing impairment or deafness may result in abnormalities of speech. Deficits of speech sound production may be associated with a hearing impairment, other sensory deficit, or a speech-motor deficit. When speech deficits are in excess of those usually associated with these problems, a diagnosis of speech sound disorder may be made. Structural deficits Speech impairment may be due to structural deficits (e.g., cleft palate). Dysarthria Speech impairment may be attributable to a motor disorder, such as cerebral palsy. Neurological signs, as well as distinctive features of voice, differentiate dysarthria from speech sound disorder, although in young children (under 3 years) differentiation may be difficult, particularly when there is no or minimal general body motor involvement (as in, e.g., Worster-Drought syndrome). Selective mutism Limited use of speech may be a sign of selective mutism, an anxiety disorder that is characterized by a lack of speech in one or more contexts or settings. Selective mutism may develop in children with a speech disorder because of embarrassment about their impairments, but many children with selective mutism exhibit normal speech in "safe" settings, such as at home or with close friends.